Please Read Through This Part of the Form and the Part RSR-F Guidance Notes Before You

Please read through this part of the form and the part RSR-F guidance notes before you fill it in.

Fill in this part for all applications for a radioactive substances activity.

If you need help filling in this form, please contact the person who sent it to you or contact us as shown below. Phone: 0300 065 3000

Email:

Website:

Contents

1 Permit type

2 Working out charges

3 Payment

4 The Data Protection Act 1998

5 Confidentiality and national security

6 Declaration

7 Application checklist

8 Where to send your application

9 How to contact us

Form: RSR Part F1Page 1 of 7NRW Version 2, January 2017

OFFICIAL – SENSITIVE (when filled in and part of an application relating to sealed sources)

1 Permit type
If your application relates to permit type G or H (and is not an application for transfer or surrender) provide a copy of your calculations showing how you determined the permit type.
Reference
2Working out charges
2a Is your application for a variation to change a fixed condition registration to a standard rules permit?
Yes / ☐ / Answer question 2e, then go to section 4 (there is no charge)
No / ☐ /
2b Is your application for an administrative variation only?
Yes / ☐ / Go to section 4 (there is no charge)
No / ☐ /
2c Does your application relate to a radioactive substances activity on a nuclear licensed site?
Yes / ☐ / Go to section 4 (we will charge you on a time and materials basis)
No / ☐ /
2d Does your application relate to the disposal of solid low-level radioactive waste (including high-volume
Yes / ☐ / Go to section 4 (we will charge you on a time and materials basis)
No / ☐ / Fill in the table below
RSR Permit type (see note 1) / Application type (see note 2) / Charges due (£) (see note 3)
Note 1: A – H as described in the charging scheme guidance.
Note 2: New, variation, transfer or surrender.
Note 3: As specified in the charging scheme guidance. Please print or copy this page as confirmation of the
application charge payable and for use in raising the payment. We will not be sending you an invoice to cover this charge.
2e If your permit type is A, is each source you hold a gaseous tritium light device?
Yes / ☐ / (this does not affect the application fee but may affect your subsistence charge)
No / ☐ /
2f If you are claiming the reduced fee for a ‘minor technical’ variation (permit types D, G and H only), give your reasons
Explanation
2g If you are claiming the reduced fee for a surrender application (permit types G and H only), give your reasons
Explanation
3 Payment
Important: The fields below are mandatory. If you do not complete this section in full your application will be treated as ‘not received’ and may be sent back to you.
In order for us to process your application, please ensure you answer all questions correctly.
3aHow do you want to pay?
Tick an option below to show how you will pay.
Electronic transfer (for example, BACS) / ☐ / Go to section 3b
Credit or Debit card / ☐ / Go to section 3c
Cheque / ☐ / Go to section 3d
Postal order / ☐ / Go to section 3d
3bPaying by electronic transfer
If you choose to pay by electronic transfer use the following information to make your payment.
Company name: / Natural Resources Wales
Company address: / Income Dept., PO BOX 663, Cardiff, CF24 0TP
Bank: / RBS
Address: / National Westminster Bank Plc, 2 ½ Devonshire Square, London, EC2M 4BA
Sort code: / 60-70-80
Account number: / 10014438
Reference number
You can use any reference number but we prefer the number to be ‘EPR’ followed by the first nine letters of your organisation name followed by a four-digit number.
For example, for a company named Joe Bloggs Ltd, the reference number might be EPRJOEBLOGGS0001. (Remember you can use any four-digit number at the end.)
The reference number you will provide will appear on our bank statements so we can check your payment. We may need to contact your bank to make sure the reference number is quoted correctly.
You should also email your payment details and payment reference number to / or fax it to 0300 065 3001 and enter it in the space provided below.
Amount paid
Applicant name
Payee name (if different from above)
Date paid (DD/MM/YYYY)
BACS reference
Making payments from outside the UK
These details have changed. If you are making your payment from outside the United Kingdom (which must be received in sterling), our IBAN number is GB70 NWBK6070 8010 014438 and our SWIFT/BIC number is NWBKGB2L.
If you do not quote your payment reference number, there may be a delay in processing your payment and application.
3cPaying by credit or debit card
If you are paying by credit or debit card, please fill in the separate form CC1.
You can download this from our website or you can ask for one of our customer service providers to send one by post. We will destroy your card details once we have processed your payment. We can accept payments by Visa, MasterCard or Maestro UK card only.
3dPaying by cheque or postal order
You should make cheques or postal orders payable to Natural Resources Wales and they should be marked ‘A/c Payee’.
We will not accept post-dated cheques (cheques with a future date written on them).
Cheque/ postal order number
Amount paid
4 The Data Protection Act 1998
We, the Natural Resources Body for Wales (hereafter “Natural Resources Wales”), will process the information you provide so that we can:

deal with your application;
make sure you keep to the conditions of the licence, permit or registration;
process renewals; and
keep the public registers up to date.

We may also process or release the information to:

offer you documents or services relating to environmental matters;
consult the public, public organisations and other organisations (for example, the Health and Safety Executive, local authorities, the emergency services, the Department for Environment, Food and Rural Affairs) on environmental issues;
carry out research and development work on environmental issues;
provide information from the public register to anyone who asks;
prevent anyone from breaking environmental law, investigate cases where environmental law may have been broken, and take any action that is needed;
assess whether customers are satisfied with our service, and to improve our service; and
respond to requests for information under the Freedom of Information Act 2000 and the Environmental Information Regulations 2004 (if the Data Protection Act allows). We may pass the information on to our agents or representatives to do these things for us.

5 Confidentiality and national security
We will normally put all the information in your application on a public register of environmental information.
However, we may not include certain information in the public register if this is in the interests of national security, or because the information is confidential
Confidentiality
You can ask for information to be made confidential by enclosing a letter with your application giving your reasons.
If we agree with your request, we will tell you and not include the information in the public register. If we do not agree with your request, we will let you know how to appeal against our decision, or you can withdraw your application.
Only tick the box below if you wish to claim confidentiality for your application.
Please treat the information in my application as confidential / ☐ /
Tick the box to confirm you have provided evidence to support your confidentiality claim and give us the document reference, below. / ☐ /
Document reference
National security
You can tell the Welsh Ministers that you believe including information on a public register would not be in the interests of national security. You must enclose a letter with your application telling us that you have told the Welsh Ministers and you must still include the information in your application. We will not include the information in the public register unless the Welsh Ministers decide that it should be included.
Note: All applications relating to sealed sources are automatically subject to national security restrictions – only tick the box if there is some other reason for claiming national security.
I believe that including my information in the public register would not be in the interests of national security. / ☐ /
Tick the box to confirm you have provided evidence to support your national security claim and give us the document reference, below. / ☐ /
Document reference
6 Application checklist (you must fill in this section)
Tell us about the supporting evidence and information you have sent with this application.
Application fee–only applicable if you have completed the table in question 2d
You must submit the correct application fee in line with our current charging scheme.
Tick the box to say you have included the correct fee. / ☐ /
List all the documents you have included in Table 1. Please see the guidance notes for examples on how to complete the checklist.
If the relevant information for a question forms part of a larger document, please specify the relevant section(s) of the document. This will speed up the process of checking your application and making decisions.
If necessary, continue on a separate sheet and tell us the reference you have given the document below.
Document reference
Table 1 – application checklist
Question reference / Document title/ reference / Document section
7 Declaration
You must read this section before making the declaration and sending your form to us.
For transfer applications - Both you and the person receiving the permit must make the declaration.
Section 7cmust be completed by the current holder and Section 7d must be completed by the proposed new holder.
A relevant person should make the declaration. You must be a relevant person or have the authority of a relevant person to sign this application on their behalf.
Relevant people means each applicant, and in the case of a company, a director, manager, company secretary or any similar officer or employee listed on current appointments in Companies House. In the case of a Limited Liability Partnership (LLP), it includes any partner. If the permit holder is an organisation of individuals, each individual (or individual trustee) must complete the declaration.
To simplify and speed up the application process we recommend that the declaration is filled in by an officer of a company or one of the partners in a Limited Liability Partnership (LLP).
If you wish a manager, employee or consultant etc. to sign the declaration on behalf of a relevant person, we will need written confirmation from a relevant person; that is, an officer of the company, a partner in the LLP or the individual, confirming that the person has the authority to fill in the declaration.
If you are joint permit holders you should each fill in your own declaration. We have provided extra spaces for this below. Please send in a separate sheet with your application if you need more room for signatories.
Where the operator is the subject of any insolvency procedure, the declaration must be filled in by the official receiver/appointed insolvency practitioner.
7a Are you signing the form on behalf of a relevant person?
If you are not a relevant person, but want to sign the application on their behalf, you must include confirmation that you can do this.
I have included written confirmation from a relevant person to confirm I can sign on their behalf. / ☐ /
7b Does your application include a standard facility?
If your application includes a standard facility, you also need to confirm that you are able to meet all relevant criteria of the standard rule set/sets for which you are applying.
I confirm that my standard facility will fully meet the rules that I have applied for. / ☐ /
7cDeclaration
If you’re transferring the permit, the current holder or holders should sign this section of the declaration, and the proposed new holder or holders of the permit should sign the declaration in section 7d.
If you knowingly or recklessly make a statement which is false or misleading to help you get an environmental permit (for yourself or another person), you are committing an offence under the Environmental Permitting (England and Wales) Regulations 2016.
I declare that the information in this application is true to the best of my knowledge and belief. I understand that this application may be refused or approval withdrawn if I give false or incomplete information.
I understand that if I knowingly or recklessly make a false or misleading statement:

I may be prosecuted; and
if convicted, I may have to pay a fine and/or go to prison.

By signing below, you are confirming that you understand and agree with the declaration above.
Title
First name
Last name
On behalf of (if relevant)
Today’s date
If you knowingly or recklessly make a statement which is false or misleading to help you get an environmental permit (for yourself or another person), you are committing an offence under the Environmental Permitting (England and Wales) Regulations 2016.
I declare that the information in this application is true to the best of my knowledge and belief. I understand that this application may be refused or approval withdrawn if I give false or incomplete information.
I understand that if I knowingly or recklessly make a false or misleading statement:

I may be prosecuted; and
if convicted, I may have to pay a fine and/or go to prison.

By signing below, you are confirming that you understand and agree with the declaration above.
Title
First name
Last name
On behalf of (if relevant)
Today’s date
7dDeclaration for the person or persons receivingthe permit (transfers only)
The persons ‘receiving the permit’ is the proposed new permit holder.
Note: If you cannot trace a person or persons holding the permit you may be able to transfer the permit without their declaration (in section 7d above). Please contact us to discuss this and supply evidence in your application to confirm you are unable to trace one or all of the permit holders.
If you knowingly or recklessly make a statement which is false or misleading to help you get an environmental permit (for yourself or another person), you are committing an offence under the Environmental Permitting (England and Wales) Regulations 2016.
I declare that the information in this application is true to the best of my knowledge and belief. I understand that this application may be refused or approval withdrawn if I give false or incomplete information.
I understand that if I knowingly or recklessly make a false or misleading statement:

I may be prosecuted; and
if convicted, I may have to pay a fine and/or go to prison.

I may be prosecuted; and
if convicted, I may have to pay a fine and/or go to prison.

By signing below, you are confirming that you understand and agree with the declaration above.
Title
First name
Last name
On behalf of (if relevant)
Today’s date
8Where to send your application
If your application relates to sealed radioactive sources:
You must send all parts of your completed application form and supporting documents by post, to:
Permitting team leader (Regulated Industry), Natural Resources Wales, 5th Floor, Cambria House, 29 Newport Road, Cardiff, CF24 0TP
If your application does not relate to sealed radioactive sources:
You may send the application by post, to the address above. Or you can email it to:

Form: RSR Part F1Page 1 of 7NRW Version 2, January 2017

OFFICIAL – SENSITIVE (when filled in and part of an application relating to sealed sources)